Newport Healthy Residents, Healthy Homes

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Newport Healthy Residents, Healthy Homes

• Training Session 1
• 2 November 2006
• Developed by
• Ellen Tohn, Tohn Environmental Strategies LLC
• Chris Camillo
• Funding Provided by
• US Agency for Healthcare Research and Quality

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Project Timeline

• Today Training Session 1
• 11/8 Training Session 2 (role plays)
• 11/8-11/15 Pilot with 5-6 families
• 11/16 HRHH Coalition meeting
• November December revise and use
• January finalize materials and protocols
• Beyond keep using in Newport, across RI

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Training Session 1

• HRHH goals, purpose and limitations
• Health behaviors and communication
• Asthma
• In good control vs not in good control
• Factors that affect asthma control
• Conditions
• Things that can be done to get better control
• Responses
• Practice talking about the project and using its
  tools to help residents families

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Exposure-Disease Paradigm
Environmental hazards pollutants
Exposure
Internal dose
Biologically effective dose
Health effect
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Newport HRHH is . . .

• Its goals are . . . .
• It does . . . . .

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HRHH cant do . . . .
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Asthma in Rhode Island

• Asthma is a statewide issue
• RI 10.7 childhood lifetime asthma prevalence
• Asthma Regional Council, January 2004
• Greater impact in RI core cities
• Childhood hospitalization rate, 2000-2004
• 3.6 per 1000 for RI 5.2 per 1000 for core cities
• Woonsocket 4.2 per 1000 children
• Pawtucket 4.2 per 1000 Providence 6.1 per
  1000
• RI Kids Count, 2006 Factbook,
• Rhode Islanders do not know how to control
• only 18 described inflammation as underlying
  cause
• 49 believed attacks could only be treated, not
  prevented
• Asthma in America survey, 1999,
  www.asthmainamerica.com

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Asthma Hospitalizations by Race/Ethnicity per
1,000 Children Under Age 18, RI, 2000-20041
12006 RI Kids Count Factbook, Children with Asthma
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Asthma among residents in family units at Newport
Housing Authority
select results from Summer 2006 resident survey,
Newport Housing Authority
10
select results from Summer 2006 resident survey,
Newport Housing Authority
11
select results from Summer 2006 resident survey,
Newport Housing Authority
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Residents without Health Insuranceat any time in
the last 12 months
select results from Summer 2006 resident survey,
Newport Housing Authority
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select results from Summer 2006 resident survey,
Newport Housing Authority
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To Successfully Control Asthma

• Go to MD visits and have a good treatment plan
• Take medicines daily to prevent symptoms
• Avoid triggers
• Stay active
• Problem solved, lets go home

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Optimal Use of Asthma Meds
Walders N, Kopel S, Koinis-Mitchell D, McQuaid,
E. Patterns of Quick-Relief and Long-term
Controller Medication Use in Pediatric Asthma.
Journal of Pediatrics, Feb 2005
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Asthma Medication Use Real Life
Walders N, Kopel S, Koinis-Mitchell D, McQuaid,
E. Patterns of Quick-Relief and Long-term
Controller Medication Use in Pediatric Asthma.
Journal of Pediatrics, Feb 2005
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Knowledge-Action Gaphealth behviors

• CDC Recommends
• 30 mins of moderate physical activity 5 or more
  days per week
• 5 servings of fruits and vegetables each day
• 1000-1200 mg of calcium each day
• Floss teeth daily
• Get a flu shot each year

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Transtheorical Model1stages of change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Transcendence

• no way
• I might
• Im gonna
• Im doing it
• Im still doing it
• You should do it too!

1Prochaska, J. O., Velicer, W. F. (1997). The
transtheoretical model of health behavior change.
American Journal of Health Promotion, 12, 3848.
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Tips for Effective Communicationtop 10 answers
are on the board

• Keep an open mind
• Ask open ended questions
• Pay attention to non-verbal clues
• Be conscious of your body language

• Use active listening
• Paraphrase / repeat
• Be honest
• Be respectful
• confidentiality
• Focus on resident goals and needs
• Leave with a clearly defined next steps

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What is Asthma?

• Asthma is a Chronic Lung Disease
• Airways swell
• Airways tighten
• Asthma Can Be Controlled
• Take medicines
• Avoid triggers

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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A Normal Breath

• Lungs are like an upside down tree!
• Air goes down windpipe (trunk)
• Moves to the bronchi (branches)
• Ends up in the air sacs (leaves)

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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What is Asthma?

• Inflammation
• Airways Swell/ Mucus
• Bronchoconstriction
• Muscles Tighten
• Hypersensitive airways
• Chronic but controllable
• Severity levels
• mild intermittent to severe persistent

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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During Asthma Episodes

• Lung are inflamed
• Mucous clogs the tubes (airways)
• Muscles around airways tighten
• Airways become hyperactive

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Early Warning Signs

• What people feel
• Hard time breathing
• Tight chest
• Wheezing/Coughing
• Ticklish throat
• Overtired
• Upset stomach
• Allergies (itch they cant scratch)

• What Others Notice
• Wheezing/coughing
• Allergy signs
• Allergic Shiners
• Infection signs
• Stroking throat
• Behavior change (tired, clingy, upset)

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Medications for Asthma

• Long-term controller
• Reduce Inflammation
• Reduce Mucus
• Controls symptoms
• Flovent, Advair, Pulmicort
• Singulair
• Quick-relief
• Bronchodilator
• Relax muscles around airways
• Albuterol (inhaler and nebulizer machine)

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Why People Should Take Long Term Controller
Medicines

• To reduce the need for quick-relief medications
• To prevent asthma episodes
• To avoid long term lung damage
• To prevent trips to the hospital
• To go to school and participate in activities
• To sleep all night

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Triggers of Asthma

• Find out what your asthma triggers are to design
  a plan for trigger control.

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Identify Your Asthma Triggers

• Exposure to triggers causes bronchoconstriction
  and inflammation
• Triggers come in three major types
• Allergens (such as pollen, mold, cat)
• Irritants (such as cigarette smoke, cold air)
• Aggravators (such colds, weather, exercise)

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Identify TriggersPotential Triggers in a Home

• Allergens
• Animals / pets
• Mold
• Dust mites
• Cockroaches
• Food
• Pollen

• Irritants
• Fumes Odors
• paints, cleaning supplies, chemicals
• Cigarette Smoke
• Chalk dust
• Exhaust / pollution
• Scented candles

• Aggravators
• Cold/flu
• Weather
• Exercise

Adapted from CVS/pharmacy Draw A Breath Program
at Hasbro Childrens Hospital
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Dust Mite
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The Fire of Asthma

• The marble story

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Is asthma in good control oris asthma not in
good control?

• RULE OF 2s (modified)
• More than 2 asthma episodes a week (symptoms more
  than twice per week)
• Awake more than twice a month with asthma
  symptoms
• Use quick relief medicine more than 2 times per
  week to treat symptoms

Rule of Two, a registered service mark of the
Baylor Health Care System
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Is asthma in good control oris asthma not in
good control?

• In the last 4 weeks, how often have you had
  symptoms of asthma
• 3-6 times per week
• In the last 4 weeks, how often did you wake up
  at night due to asthma symptoms
• Not at all
• In the last 4 weeks, how many days did you use
  albuterol/quick relief med for asthma symptoms
• Every day of the week
• Plus missed work 2 days in last month went to
  emergency department 2 times in last year

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Is asthma in good control oris asthma not in
good control?

• In the last 4 weeks, how often have you had
  symptoms of asthma
• 1-2 times per week
• In the last 4 weeks, how often did you wake up
  at night due to asthma symptoms
• Not at all
• In the last 4 weeks, how many days did you use
  albuterol/quick relief med for asthma symptoms
• Not at all
• Plus missed 1 day of school in last year, no
  hospitalizations or emergency dept visits

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To Successfully Control Asthma

• Go to MD visits and have a good treatment plan
• Take medicines daily to prevent symptoms
• Avoid triggers
• Stay active

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Why might asthma not be in good control?

• What conditions contribute?

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Conditions contributing to poor control

• No medical home/regular medical care
• Too expensive, cant get to appointments,
  language
• No or limited health insurance
• High co-pays, cant afford prescriptions or MD
  visits
• Smoking
• Triggers in the home
• Doesnt know about asthma
• Can be controlled, what steps to take
• Doesnt believe he/she can control asthma
• Self efficacy

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If asthma is not in good control . . .

• What responses are available through HRHH?

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Responses, Medical Home

• During the initial home visit
• Does (each family member) have a doctors office
  where he/she goes for check-ups and when sick?
• When is the last time (family member) went to
  the doctor for a well check-up?
• Possible resident responses
• Ok and possible problem
• If problem, suggest a referral to social service
  team member who will
• Contact the family
• Identify root causes of problem (money,
  transportation, language) help

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Responses, Health Insurance

• During the initial home visit
• Does (each family member) currently have health
  insurance?
• Possible resident responses
• Ok and possible problem
• If problem, suggest a referral to social service
  team member who will
• Contact the family
• Screen the family to see if eligible. If not,
  find a MD that sees patients regardless of
  ability to pay

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Responses, Smoking

• During the initial home visit
• How many people in the home smoke?
• Does the smoker smoke inside the home?
• Possible resident responses
• Assess readiness to quit or reduce smoking
• If family interested, suggest a referral to
  social service team member who will
• Contact the family
• Screen the family to see what programs are
  available to the patient based on health
  insurance or other criteria

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Responses, Triggers in Home

• During the initial home visit
• Conversation questions
• Have had any pest in your home in the last 4
  months?
• In last year, has there been a 24-hour period
  where your home was excessively hot? Cold?
• Walkthrough questions
• Evidence of water leaks or mold moisture
  readings
• Pests
• Bedroom of asthmatic carpeting, covers
• Possible resident responses
• Suggest a referral to maintenance team member and
  start a work order
• Contact the family, assess, and repair

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What did we learn today?

• What do you want to learn more about next time?

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Next time

• November 8, 9a at
• Protocols and forms
• Role plays and practice
• Questions feedback
• Homework
• Review protocols forms section of binder